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dc.contributor.author | Chi, B.H. | |
dc.contributor.author | Yiannoutsos, C.T. | |
dc.contributor.author | Westfall, A.O. | |
dc.contributor.author | Newman, J.E. | |
dc.contributor.author | Zhou, J. | |
dc.contributor.author | Cesar, C. | |
dc.contributor.author | Brinkhof, M.W.G. | |
dc.contributor.author | Mwango, A. | |
dc.contributor.author | Balestre, E. | |
dc.contributor.author | Carriquiry, G. | |
dc.contributor.author | Sirisanthana, T. | |
dc.contributor.author | Mukumbi, H. | |
dc.contributor.author | Martin, J.N. | |
dc.contributor.author | Grimsrud, A. | |
dc.contributor.author | Bacon, M. | |
dc.contributor.author | Thiebaut, R. | |
dc.date.accessioned | 2022-01-18T19:34:37Z | |
dc.date.available | 2022-01-18T19:34:37Z | |
dc.date.issued | 2011 | |
dc.identifier.uri | https://hdl.handle.net/20.500.12866/11060 | |
dc.description.abstract | Background: Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. Methods and Findings: At a set "status classification" date, patients were categorized as either "active" or "LTFU" according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities-representing 180,718 patients from 19 countries-were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173-181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%-7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean = 150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean = 1.2%, 95% CI: 1.0%-1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean = 19.9%, 95% CI: 19.1%-21.7%). Conclusions: Based on this evaluation, we recommend the adoption of ≥180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that underlie patient attrition and establishing more reliable and comparable program evaluation worldwide. | en_US |
dc.language.iso | eng | |
dc.publisher | Public Library of Science | |
dc.relation.ispartofseries | PLoS Medicine | |
dc.rights | info:eu-repo/semantics/restrictedAccess | |
dc.rights.uri | https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es | |
dc.subject | Humans | en_US |
dc.subject | cohort analysis | en_US |
dc.subject | Cohort Studies | en_US |
dc.subject | controlled study | en_US |
dc.subject | rural area | en_US |
dc.subject | Delivery of Health Care | en_US |
dc.subject | Latin America | en_US |
dc.subject | South and Central America | en_US |
dc.subject | HIV Infections | en_US |
dc.subject | Human immunodeficiency virus infection | en_US |
dc.subject | statistics | en_US |
dc.subject | HIV | en_US |
dc.subject | Follow-Up Studies | en_US |
dc.subject | standardization | en_US |
dc.subject | highly active antiretroviral therapy | en_US |
dc.subject | urban area | en_US |
dc.subject | health care delivery | en_US |
dc.subject | Antiretroviral Therapy, Highly Active | en_US |
dc.subject | Patient Compliance | en_US |
dc.subject | health center | en_US |
dc.subject | Africa | en_US |
dc.subject | health care | en_US |
dc.subject | patient care | en_US |
dc.subject | health care facility | en_US |
dc.subject | accuracy | en_US |
dc.subject | data analysis | en_US |
dc.subject | Asia | en_US |
dc.subject | Terminology as Topic | en_US |
dc.subject | Lost to Follow-Up | en_US |
dc.subject | nomenclature | en_US |
dc.subject | patient coding | en_US |
dc.subject | treatment refusal | en_US |
dc.title | Universal definition of loss to follow-up in HIV treatment programs: A statistical analysis of 111 facilities in Africa, Asia, and Latin America | en_US |
dc.type | info:eu-repo/semantics/article | |
dc.identifier.doi | https://doi.org/10.1371/journal.pmed.1001111 | |
dc.subject.ocde | https://purl.org/pe-repo/ocde/ford#3.03.08 | |
dc.relation.issn | 1549-1676 |
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